Provider Demographics
NPI:1770621146
Name:ALEALI, MARJAN (MD)
Entity type:Individual
Prefix:DR
First Name:MARJAN
Middle Name:
Last Name:ALEALI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 W SPRING VALLEY AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MAYWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07607-1445
Mailing Address - Country:US
Mailing Address - Phone:201-525-1031
Mailing Address - Fax:201-880-4560
Practice Address - Street 1:255 W SPRING VALLEY AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:MAYWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07607-1445
Practice Address - Country:US
Practice Address - Phone:201-525-1031
Practice Address - Fax:201-880-4560
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07463700208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
064693Medicare ID - Type Unspecified
NJH50460Medicare UPIN